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After accounting for differences due to age, smoking and heart disease – all risk factors for ED – Chew and colleagues found that drinkers experienced rates of impotence 25% to 30% below those of teetotallers.
Lack of scientific studies on effectiveness
Schedule regular exercise into your daily routine. Add a variety of exercises so that you do not get bored. Look into scheduled exercise classes at your local community center.
2 Department of Otolaryngology—Head and Neck Surgery, Johns Hopkins University, Baltimore, MD 21287
Erection requires a sequence of events. Erectile dysfunction can occur when any of the events is disturbed. Nerve impulses in the brain, spinal column, around the penis and response in muscles, fibrous tissues, veins and arteries in and around the corpora cavernosa constitute this sequence of events. Injury to any of these parts which are part of this sequence (nerves, arteries, smooth muscles, fibrous tissue) can cause ED.
Psychogenic impotence is relatively uncommon. It is characterized objectively by the presence of good nocturnal and morning erections and negative findings from all other tests. During the interview, a history of highly variable erections that can be totally absent one day but virtually normal the next suggests a psychogenic cause. Virtually 100% of men with severe depression have erectile dysfunction (ED). Sildenafil (Viagra) works well for psychogenic ED; other treatment modalities are also effective because the tissues, nerves, hormone levels, and vasculature are normal. The authors usually recommend a full psychological evaluation in these patients so that the underlying etiology can be identified and treated appropriately rather than just treating the symptom of ED. Therefore, the authors defer treatment of the patient's ED until he has begun psychological testing and therapy for the underlying problem.
Currently in phase II development, Zoraxel is based on clavulanic acid and allegedly alters brain dopamine and serotonine levels, thus improving erectile function.
The answer: it depends. The issue is less actual size than perception of size.
Because there is no conclusive evidence about the effectiveness of hormonal blood tests or treatment in patients with low testosterone levels, the ACP doesn't recommend for or against routine use of the tests in ED patients. The college says doctors should make decisions to measure hormone levels based on an individual patient's clinical symptoms (decreased libido, premature ejaculation, fatigue, etc.) and physical signs (such as testicular or muscle atrophy) that suggest hormone problems.
Psychological issues such as anxiety or depression
"The findings presented by these authors are interesting and certainly have potential clinical implications for the various forms of dystrophinopathy [heart damage]," she said, adding that heart failure is a major cause of illness and death in late-stage Duchenne muscular dystrophy.
Lipid profile: This blood test measures the level of lipids (fats), like cholesterol. High levels may indicate atherosclerosis (hardening of the arteries), which can affect blood circulation in the penis.
Nocturnal penile tumescence (NPT) to check for normal nighttime erections
Inpatient & Outpatient Medications
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Asian ginseng (Panax ginseng) – Traditionally used for male impotence, though no current studies support this usage.
Replacement androgens are available in oral, injectable, gels and transdermal preparations. Oral therapy is the least effective and the most likely to be associated with hepatotoxicity, even though this is a relatively small risk. Parenteral therapy is most likely to restore androgen levels to the reference range, but this therapy requires periodic injections, usually every 2 weeks, to sustain an effective level. Peak and trough levels are suggested when using injectable agents to avoid symptomatic troughs and supernormal peak levels. Weekly injections using lower doses can be used to minimize the wide swings in blood levels with less frequent dosing. Skin patches deliver a sustained dose and are generally accepted by patients. Androgen creams (AndroGel and Testim) are now available for daily topical use for male hypogonadism and have the advantage of minimizing the peaks and troughs of injectable agents. However, they require daily dosing and are relatively expensive.
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